Ibrutinib associated with accelerated hypertension

July 2021 Clinical practice Tobias Rawson

Ibrutinib is a tyrosine kinase inhibitor that blocks the B-cell receptor, which is crucial in B-cell development and is aberrantly active in B cell cancers. Unfortunately, ibrutinib is commonly associated with atrial fibrillation and other cardiotoxicities, including accelerated hypertension. Until recently, the incidence and risk factors associated with new or worsening hypertension, following ibrutinib treatment, have not been established in literature. Now, researchers from the University of Pennsylvania shed light on this association.

Study design

This retrospective study collected data from 144 patients diagnosed with B cell malignancies who were either treated with ibrutinib (N= 93) or conventional chemoimmunotherapy (N= 51). Blood pressure was evaluated at 1, 2, 3 and 6 months after treatment initiation. Additionally, descriptive statistics were used to compare baseline characteristics for each treatment group.

61.2% of hypertensive patients received inadequate treatment

At baseline, irutinib-treated patients and those receiving chemoimmunotherapy had a comparable prevalence of hypertension; 63.4% and 66.7%, respectively. Baseline characteristics were balanced between the two groups, with no differences between age, sex, a baseline cardiac morbidities. Ibrutinib significantly increased both systolic and diastolic blood pressure, compared to baseline. In contrast, chemoimmunotherapy was not associated with any significant changes in blood pressure. Significant increases in blood pressure, defined as > 10 mmHg, was seen in 36.6% of patients treated with ibrutinib, compared to 7.9% of chemoimmunotherapy patients after 1 month. Additionally, 61.2% of hypertensive patients treated with ibrutinib did not receive adequate blood pressure management, such as initiation of blood pressure medication, or an increase in pre-existing anti-hypertensive medication. Furthermore, only 52.9% of ibrutinib-treated patients who experienced an elevation in systolic blood pressure of 20 mm Hg or more received hypertension management changes.

Conclusions

This retrospective study provides evidence of ibrutinib-associated hypertension in patients receiving ibrutinib for B-cell malignancies. Additionally, this study sheds light on practice habits, identifying a potential gap in the management of these patients, who evidently require, and in many cases, lack, appropriate hypertension treatment alongside their ibrutinib-based therapy. Oncologists and cardiologists must be aware of the hypertensive nature of ibrutinib.

Reference

Lee DH et al., Association between ibrutinib treatment and hypertension. BMJ. 2021. [epub]. .

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